tbuckley/cabot-search huggingface dataset:
Abstract 15797: Cardiovascular Outcomes of Bariatric Surgery and Anti-Obesity Medications in Patients With New Onset Heart Failure and Obesity
Authors: Amgad Mentias, Milind Y Desai, Ali Aminian, Leslie Cho, Miriam Jacob, Paulino Alvarez, Subodh Verma, Javed Butler, Steven E Nissen, Ambarish Pandey
Journal: Circulation (2022)

Background: Intentional weight loss with bariatric surgery is associated with better outcomes in younger patients with prevalent HF. However, temporal trends in use of bariatric surgery and anti-obesity medications (AOM) among older patients with new onset HF and obesity, and their effect on CV outcomes are not well studied. Methods: Medicare patients with obesity and new onset HF from 2013 to 2019 were identified using the 100% inpatient files. Patients who underwent bariatric surgery were matched to controls in a 1:2 ratio (matched on age, sex, race, BMI, and HF diagnosis year, and comorbidities). In a random 5% sample with available Part D data, HF patients with obesity who were prescribed AOM (Semaglutide, liraglutide, naltrexone or orlistat) were identified and matched to HF controls as above. Cox models were used to evaluate the association of weight loss therapies (modeled as a time-varying dependent variable) and risk of mortality, atrial fibrillation (AF), and HF readmission rate. Results: Overall, 1.5% (2684 of 174,196) patients with new onset HF and BMI ≥35 underwent bariatric surgery (46% men, age 55 y and BMI 52 Kg/m2). Bariatric surgery use increased from 0.3% in 2013 to 1.4% in 2019 (P &lt;0.01). In propensity-matched analyses (surgery N=2144 vs. control N=3920, f/u of 4.2 y), bariatric surgery following incident HF was associated with a significantly lower risk of mortality and new-onset AF (Figure), and a lower rate of HF readmissions (pre- vs. post-surgery rate: 0.9 vs. 0.3/100 person-days). In the subset with Part D data (N=36603), use of AOM was low (3.7%). In propensity-matched analysis, (AOM N=611 vs. controls N=891, f/u of 1.8 y), use of AOM were associated with 30% lower risk of mortality and 35% lower risk of AF compared with controls. Conclusions: Bariatric surgery and AOM are associated with favorable CV outcomes among HF patients with obesity. However, their utilization remains extremely low highlighting an important gap in care of HF patients with obesity.
Abstract 15342: Predictive Value of Glucose Levels in Patients Suffering From Cardiogenic Shock Complicating Myocardial Infarction
Authors: Michael Buerke, Priyanka Boettger
Journal: Circulation (2022)

Hypothesis: Elevated glucose levels on admission are common in patients with acute coronary syndrome (ACS) and have been shown to be a strong predictor of adverse outcome in both diabetic and non-diabetic patients. Methods: The purpose of the study was to assess the impact of admission glucose levels on hospital mortality in patients with infarction related cardiogenic shock. Blood glucose levels were measured from first available routine blood specimens up to 96 hours. Results: We identified 40 patients with myocardial infarction related cardiogenic shock treated at our university hospital. 45 % of the population had an admission glucose level &lt;6 mmol/L, 15 % had levels from 6 mmol/L up to 11 mmol/L and 40% above 11 mmol/L. In-hospital mortality rate was higher in patients with increased admission glucose levels (&lt;6, 6-11, and ≥11mmol/L: 27,8 %, 66,7 % and 62,5 % respectively, p &lt;0.001). Similarly, significant mortality rate differences were observed in patient subgroups stratified by admission glucose level, presence of diabetes mellitus and cardiogenic shock. Additionally, a reduction of elevated blood glucose levels within six hours to near-normal values resulted in a favorable outcome (reduction within 6 hours vs. not within 6 hours: 25 % vs. 45 %, p&lt;0.05). Interestingly Predictors of in-hospital mortality were age, admission glucose levels, diabetes mellitus, and renal failure. Conclusions: Blood glucose level on admission is a strong predictor of in-hospital mortality in patients with infarction related cardiogenic shock. Impact of admission glucose level on mortality is independent from clinically manifested diabetes and cardiogenic shock presence. Further analysis showed better survival in patients whose elevated blood glucose levels were reduced within 6 hours to normal or near-normal ranges.
Abstract 14498: Cardiogenic Shock Intravascular Cooling Trial (CHILL-SHOCK)
Authors: Nikhil Gupta, Nikhil Singh, Nadeem Bandealy, Maryam Emami Neyestanak, Stephanie Besser, Cynthia Arevalo, Janet Friant, John Blair, Sandeep Nathan, Atman Shah, Rohan Kalathiya, Jonathan D Paul
Journal: Circulation (2022)

Introduction: Despite advances in revascularization and mechanical support, cardiogenic shock (CS) remains a highly morbid clinical state with 30-day mortality approaching 50%. Therapeutic hypothermia (TH) has been demonstrated to improve hemodynamics and reduce inflammation in small studies, but prospective randomized data is limited. We aimed to assess the safety and hemodynamic effects of TH (33 °C for 24 hours) in patients with CS. Methods: A total of 20 patients in CS were randomized to either TH plus standard therapy or standard therapy alone in this pilot study. Patients randomized to TH were cooled and rewarmed via intravenous cooling catheter. The primary safety endpoint was a composite of bradycardia requiring treatment, bleeding requiring transfusion as a result of catheter placement or secondary to resulting coagulopathy, shivering, hyperglycemia requiring insulin for non-diabetic patients, electrolyte derangement unexplained by other therapies, and complications from cooling catheter insertion. Secondary endpoints included hemodynamic parameters (cardiac output, pulmonary artery pressure, systemic vascular resistance, and cardiac power index). Results: There were no statistically significant differences in the composite analysis of prespecified safety outcomes (3 events in TH group vs 0 events in control group, p = 0.24). Patients randomized to TH demonstrated a statistically significant increase in cardiac index (3.6 [3.1, 3.9] L/min/m 2 vs 2.6 [2.5, 3.2] L/min/m 2 , p = 0.03) and cardiac power index (0.61 [0.55, 0.70] W/m 2 vs 0.53 [0.44, 0.57] W/m 2 , p = 0.03) compared to the control group at 48-96 hours after randomization. There were no statistically significant differences between the two groups for other collected hemodynamic variables. Conclusions: TH is a safe adjunct therapy for patients presenting with CS and may yield improvement in specific hemodynamic parameters. Larger studies are necessary to better understand the clinical benefits of TH in patients presenting with CS.
Abstract 15847: Mass Cytometry Reveals Immune Cell Subtypes Responsive to Il-1b and Il-6 Stimulation in CAD Subjects and Controls
Authors: James McParland, Jesse Cochran, Chantel McSkimming, Hema Kothari, Maria Murach, Nisha Hosadurg, Toral Patel, Stefan Bekiranov, Todd Villines, Coleen A McNamara
Journal: Circulation (2022)

Introduction: Inflammation plays a key role in the development of atherosclerosis, yet targeted therapies are lacking. Previous trials have demonstrated that IL-1b is a potential target, albeit with adverse effects on immune suppression. IL-6 has emerged as another mediator of coronary artery disease. It clear that a strategy to identify a biomarker customized for inflammatory inhibition is needed. Mass cytometry shows promise as a technology for customized biomarker identification. Hypothesis: A mass cytometry panel including markers to identify circulating immune subtypes in humans and phosphorylation of key transcription factors driving downstream inflammation can identify cell subtypes most responsive to cytokine stimulation. Methods: Peripheral blood mononuclear cells (PBMCs) were isolated from patients undergoing coronary computed tomography angiography (CCTA). Using PBMCs from 12 pairs of matched subjects, we stimulated cells with vehicle, IL-6, and IL-1b. These samples were analyzed using a custom mass cytometry panel. Results: Mass cytometry analysis of PMBCs after 15 minute cytokine stimulation identified specific lymphocyte and monocyte subtypes that were particularly responsive to IL-1b and IL-6. Notably, there was clear heterogeneity in this response suggesting this approach may identify those most impacted by cytokine inhibition or those with most severe disease. Conclusions: High dimensional mass cytometry has the potential to better identify individuals at risk and those that may respond to cytokine inhibition. We are in the process of performing advanced bioinformatic analysis including machine learning to leverage this novel technology for precision medicine.
Abstract 15510: Big Heart Problems: A Case of Reversible Nonischemic Cardiomyopathy Due to Severe Hypothyroidism
Authors: Simran Minhas, Saleena Malik, Hazem Albashash, Karnik Patel, John Kern
Journal: Circulation (2022)

Introduction: Cardiomyopathy is a heterogeneous group of myocardial diseases that can result in mechanical and electrical dysfunction. Thyroid insufficiency can increase the risk of cardiovascular abnormalities through multiple mechanisms including ventricular arrhythmias, hypertension, and heart failure. Case Presentation: Our patient is a 40-year-old Hispanic female with a past medical history of papillary thyroid carcinoma with a right-sided hemithyroidectomy in 2019 who presented to the emergency department with a 1-week history of dyspnea and peripheral edema. She has a family history of sudden cardiac death in her father. She discontinued her levothyroxine 75 mcg once daily dose 6 months ago as she believed this was causing her headaches. Her vital signs were significant for a heart rate of 117 beats per minute and a blood pressure of 185/147 mmHg. Her lab work showed a thyrotropin level of 94.6 uIU/mL, free thyroxine of 0.57 ng/dL, troponin T of 22 ng/L, and proBNP of 2660 pg/mL. A transthoracic echocardiogram (TTE) demonstrated global left ventricular hypokinesis with a left ventricular ejection fraction (LVEF) of 30-35%. Her electrocardiogram (EKG) showed normal sinus rhythm and corrected QTc of 494 ms. She received levothyroxine and furosemide and was discharged with guideline directed medical therapy (GDMT). Her outpatient TTE demonstrated improved LVEF of 40-45% after two months of levothyroxine use and GDMT. Discussion: Hypothyroidism has many cardiometabolic effects that directly impact cardiac function. Impairments in cardiac contractility can result in diastolic heart failure leading to low cardiac output, low heart rate, and low stroke volume. Increased vascular permeability results in protein-rich pericardial and pleural effusions. Myxedema, or non-pitting edema can be seen in long-standing, severe hypothyroidism. An increased QTc interval occurs due to prolonged cardiac action potentials which predispose the heart to ventricular irritability. Treatment with levothyroxine can improve cardiac output and contractility, however this carries increased risk of cardiac arrhythmias and myocardial ischemia. Conclusion: Severe hypothyroidism should be considered in cases of isolated nonischemic cardiomyopathy.
Abstract 15385: Integrin Alpha 11 is a Critical Regulator of Cardiac Remodelling, Fibrosis and Infarct Formation Following Myocardial Infarction
Authors: Patrick B Meagher, Xavier Lee, Jean-Francois Desjardins, Mark K Friedberg, Christopher McCulloch, Kim Connelly
Journal: Circulation (2022)

Cardiac fibrosis (CF), a key feature of cardiac remodelling, defined as the accumulation of excessive amounts of extracellular matrix (ECM), in response to injuries such as myocardial infarction (MI). Cardiac fibroblasts within and surrounding the injured area respond to biochemical and mechanical stimuli transforming into myofibroblasts and begin to secrete collagen. Long term collagen production reduces ventricular compliance and ultimately results in further cardiac dysfunction leading to heart failure. Mechanical activation of collagen production is understood to be a significant mediator of cardiac fibrosis. However, the mechanisms via which mechanical stimuli initiate cardiac fibroblast activation are not well understood. Therefore, we sort to investigate the role of Integrin ⍺11, a collagen binding integrin which preferentially binds to type I collagen, in response to cardiac injury. Fibroblast conditional ⍺11 knockout (KO) mice demonstrated similar cardiac function to that of Wildtype littermates (WT). However, interstitial collagen I (P&lt;0.05) and III (P&lt;0.0001) content was reduce along with cardiac myocyte size (P&lt;0.0001). In response to ligation of the left anterior descending aorta ⍺11 KO mice had significantly increased Infarct size 24 hours post MI (WT=39%, ⍺11KO=64% P&lt;0.05). Larger MI’s resulted in increased mortality in ⍺11 KO mice (22% v’s 57%, P&lt;0.05) due to rupture. Cardiac function 2 days following MI measured by echo demonstrated that Fractional Area Change (FAC) (23% ±1.812 v’s 16%±2.311, P&lt;0.05) and Cardiac Output (8.53ml±1.045 v’s 4.98ml±0.67, P&lt;0.05) were significantly worse in ⍺11 KO compared to WT mice. In the later remodelling response 4 weeks post MI, FAC was again significantly worse for ⍺11 KO mice (~9% ±1.659%, P&lt;0.0001) compared to WT (~19% ± 0.9810%). Moreover, ⍺11 KO mice that survived MI had significantly more collagen I (P&lt;0.0001) content in the remote, peri-infarct and infarct zone’s than that of WT along with, a lack of hypertrophic response. In conclusion, the loss ⍺11 results in increased ventricular dilation, impairs cardiac function and, was associated with increased mortality due to rupture following MI. In mice which survived MI ⍺11 deletion led to increased CF and blunted cardiac myocyte hypertrophy.
Abstract 15243: Incidence and Predictors of Chemotherapy-Induced Cardiomyopathy in African Americans: A Single-Center Experience
Authors: Hamzah N Abduljabar, Udhayvir S Grewal, Akhilesh Babbili, Victoria Andrus, Lovekirat S Dhaliwal, Paari Dominic
Journal: Circulation (2022)

Introduction: African Americans (AA) have largely been under-represented in randomized clinical trials investigating chemotherapy-induced cardiomyopathy (CICM) associated with doxorubicin and trastuzumab. Limited and conflicting evidence has linked higher incidence of CICM among AA patients to a higher prevalence of underlying co-morbidities. Hypothesis: African Americans have a higher incidence of CICM which is associated with higher prevalence of underlying co-morbidities in these patients. Methods: We retrospectively identified and included AA patients who underwent treatment with doxorubicin and trastuzumab at our institution. CICM was defined as a decline in ejection fraction (EF) to &lt;50% OR &gt;/=10% decline in baseline EF post-treatment. A univariate analysis was performed to study the association of common co-morbidities with CICM. JMP software (SAS v 9.4) was used for statistical analysis. Results: A total of 121 patients were included for analysis, out of which, 52.1% (63/121) and 47.9% (58/121) were treated with trastuzumab and doxorubicin respectively. Majority (85.1%, 103/121) were females and the mean age was 62.4±5.2 years. Median EF pre- and post-treatment were 65% (IQR 60%,65%) and 60% (IQR 55%,65%) respectively. The cumulative incidence of CICM in our cohort was 24% (29/121). There was no statistically significant association of CICM with female sex [OR=0.79 (0.25-2.99), p=0.68], age [OR=0.99 (0.96-1.02), p=0.88], pre-treatment EF [OR=1.09 (0.96-1.94), p=0.27], hypertension [OR=1.27 (0.51-3.18), p=0.60], diabetes [OR=1.91 (0.89-4.95), p=0.13], hyperlipidemia [OR=1.19 (0.44-2.92), p=0.78] or coronary artery disease [OR=1.93 (0.68-5.93), p=0.21]. Conclusions: Per existing literature, the incidence of CICM in our cohort of AA patients is higher than general population. As historically postulated, CICM was not found to be associated with pre-existing co-morbidities. Further clinical and translational research is needed to study genetic and pathophysiological mechanisms driving CICM in AA patients.
Abstract 14754: Peak Frequency Mapping in Low Voltage Zones Can Identify the Critical Isthmus in Atypical Atrial Flutters
Authors: Maham Karatela, Robert Dowell, Daniel Friedman, Kevin L Thomas, Kevin Jackson, Jonathan P Piccini
Journal: Circulation (2022)

Introduction: Atypical atrial flutters (AFL) are a heterogeneous group of reentrant arrhythmias and can be challenging to map. Peak frequency (PF) mapping is a novel method of identifying local conductivity and may help identify critical portions of myocardial substrate supporting reentry. Hypothesis: The critical isthmuses of left atrial (LA) AFLs demonstrate a combination of low-voltage and high PF. Methods: LA omnipolar voltage and PF maps were generated using the EnSite Precision Mapping System and HD-Grid catheter in 13 patients undergoing AFL ablation. For the purpose of this study, mapping was performed during AFL and normal voltage was defined as ≥ 0.5 mV, low-voltage (LV) 0.1 - 0.5 mV, and scar &lt; 0.1 mV. PF distributions were analyzed in each tissue type. Conduction velocity (CV) was characterized across PF with correlational analysis. The 1-cm radius from sites of arrhythmia termination with ablation were analyzed to characterize mean PF and voltage in nearby myocardial tissue. Results: Mean age was 65.8 ± 9.3 years and 54% were female. A total of 37,331 points were analyzed. Sites of slow conduction included the mitral isthmus (46%), LA roof (23%), pulmonary vein antra (15%), posterior wall (8%), and anterior wall (8%). In normal voltage tissue, mean PF was 337.7 ± 115.4 Hz. LV and scar tissue had left-skewed PF distributions and lower mean PF ( p &lt; 0.0001). While CV had no trend across PF in tissue with normal voltage ( R 2 , 0.0002 to 0.1), there was moderate conduction slowing at higher PF in LV tissue ( R 2 , 0.07 to 0.30). In PF-LV overlay maps, all termination sites resided in regions of LV and high PF ( Figure ). Of the 1-cm areas neighboring termination, 77% had significantly higher PF than the global LA ( p &lt; 0.05), of which 80% had significantly lower mean voltage ( p &lt; 0.01) or mean voltage &lt; 0.5 mV. Conclusions: Sites of arrhythmia termination can be identified in LV tissue at higher PF. Low-voltage, high-PF areas may be critical targets during catheter ablation of atypical AFL.
Abstract 246: Defibrillation For Pulseless Ventricular Arrhythmias During Pediatric In-hospital Cardiac Arrest: A Report From The AHA Get With The Guidelines <sup>®</sup> -Resuscitation Registry
Authors: Sarah E Haskell, Derek Hoyme, Saket Girotra, M Bridget Zimmerman, Ron Reeder, Tia T Raymond, Ricardo Samson, Marc Berg, Robert A Berg, Vinay M Nadkarni, Dianne L Atkins
Journal: Circulation (2022)

Introduction: Approximately 15,200 children suffer an in-hospital cardiac arrest (IHCA) annually, and 10-20% will have ventricular fibrillation or pulseless ventricular tachycardia (VF/pVT). Timely defibrillation is critical for shockable rhythms, however current data are lacking on outcomes when &gt; 1 shock is required for termination of VF/pVT. Methods: From the AHA Get With The Guidelines ® -Resuscitation registry, we identified children &lt; 18 years of age who had IHCA from initial VF/pVT and received &gt; 1 shock from 2000-2020. Patients were analyzed according to total number of shocks received: 2 shocks, 3 shocks, or &gt; 4 shocks. Multivariable logistic regression models were used to test the association between number of shocks and return of spontaneous circulation (ROSC), survival to hospital discharge, and survival to hospital discharge with favorable neurologic outcome. Results: 436 patients met inclusion criteria and received &gt; 1 shock for VF/pVT. Median age was 8 years [IQR, 0.9,15.0]. Patients that required &gt; 4 shocks were older patients (11 years [1.0-15.0; p=0.013]). A higher percentage of patients receiving &gt; 4 shocks had renal insufficiency (14% vs. 7% for 2 shocks vs. 6% for 3 shocks, p = 0.041). Patients receiving &gt; 4 shocks vs. 2 shocks were less likely to achieve ROSC (OR 0.40 [0.23,0.68]; p=0.0009). There was no statistically significant difference in survival to hospital discharge for patients receiving 2 shocks (42%), 3 shocks (39%), or &gt; 4 shocks (32%) or survival to hospital discharge with favorable neurologic outcome. Conclusion: There was no significant association between the number of shocks and survival to hospital discharge or survival to hospital discharge with favorable neurologic outcome. ROSC was significantly less in patients with &gt; 4 shocks for VF/pVT compared to 2 shocks. Further research is needed to characterize energy dosing when &gt; 1 shock is needed for VF/pVT.
Abstract 14695: Prevalence of Extracoronary Vascular Abnormalities Among Patients With Spontaneous Coronary Artery Dissection: A Look at Scad Across the Lifespan
Authors: Jacqueline Visina, Nowrin Haque, Shi Huang, Esther S Kim
Journal: Circulation (2022)

Introduction: Spontaneous coronary artery dissection (SCAD) is an important cause of myocardial infarction in young women; however, SCAD has also been described in older patients. Differences in SCAD presentation, cardiovascular risk factors, presence of extracoronary vascular abnormalities (EVAs), and management across the lifespan have been understudied. Methods: Single-center cohort study of consecutive patients seen in a dedicated SCAD clinic. Medical history, radiographic, and angiographic data were collected. All patients underwent brain to pelvis CTA imaging to evaluate for EVAs. Patients were stratified into three age groups: 20-40, 40-60, and ≥60 years. Differences among age groups were evaluated using Kruskal-Wallis tests for continuous variables and Pearson Chi-squared tests or Fisher’s exact tests for categorical variables. Results: 193 patients met inclusion criteria, 94.3% women. Prevalence of hypertension (14.8%, 42.6%, and 60%, p&lt;0.001) and dyslipidemia (11.1%, 37.4%, and 53.3%, p&lt;0.001) increased with age. Precipitating factors were significantly different among age groups (p&lt;0.001) with usual exertion more commonly seen in the older cohort (25.5%, 39%, 73.3%). Peripartum SCAD (40%, 2.5%, 0%) and female sex (94.5%, 95.9%, 80%) were more commonly seen in the younger cohort (p&lt;0.001). Younger patients were more frequently discharged on anticoagulation (10.9%, 0.8%, 0%, p&lt;0.004). There were no significant differences in SCAD presentation, vessel involvement, SCAD management, and EVA prevalence. Procedural complications were not different. Conclusions: Older women who develop SCAD have more typical risk factors for ACS including hypertension, and dyslipidemia. Clinical presentation, vessel distribution, and management of SCAD do not vary across age groups. The prevalence of arteriopathies is high and similar across age groups, underscoring the importance of the evaluation for EVAs following SCAD in patients of all ages.